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20030681.pdfa DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS AA))6�Ll MAILING ADDRESS 'L-IU15 Av-1- CITY zip TELEPHONE EAY,V\ 'It 0710 1 f?,r - -n I - I � % ADDRESS CITY NAME ZIP ITELEPHONE A f4f A- )l el"A ADDRESS —? 0 D)c -7-7 CITY ZIP ��Q-e4414 4- Oita 1-) 2 STATE LICENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. tIz-- ITELEPHONE -'10(0 —so(. —10 co I FPERMIT EXPIRES USE PERMIT ZONE NUMBER JOB Ij AV4 Lj SUITE/APT# ADDRESS '2:2.602 9 a PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ IESCP App, .'M I,= PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW kad Street Use Parmil Reld EXISTING — PROPOSED lnspecWn Required Sidewalk Required undStWound REQUIRED DEDICATION— FT Wirimilfaquirod 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I I YESM NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING FIRE REVIEWED BY REVIEWED/DATE DATE VARIANCE OR CU SHORELINE OR ADS# INSPE.70N D PSOND RE, OSTED [3YES 13NO SEPA REVIEW SIGN AREA HEIGHT COMPIL E EXEMPT -1,A1110*91ft Chkl) I ALLOWED PROPOSED W cc M If EXP �-)I; T EOR E9 I LOT cqWRT,,12-JL RE. 6 �'PCVED SETBACKS (Fr.) L/R SIDE REAR ALLOWED F FMF PARKING LOT AREA PLANNING REVIEWED BY DATE [3 NEW RESIDENTIAL [3 PLUMBING / MECH ADDITION E3 COMMERCIAL o COMPLIANCE OR CHANGE OF USE 0 REMODEL [3 APARTMENT [3 SIGN 0 REPAIR [3 GRADING CYOS _ r] FENCE ( — X [3 DEMOLISH Q'ITANK [3 OTHER GARAGE CARPORT RETAINING WALL 13 ROCKERY E3 RENEWAL WRE OF USE. BUSINESS OR ACTIVIRY) EXI4AIN: 'De.,LIDVI�k '300 SAOVI� NUMBER NUMBER"6F CRITICAL OF DWELLING I AREAS I STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE REO'D I PROVIDED FT) REMARKS I HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT Al RIMS ONLY THE WORK NOTED. THIS PERM111' COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLM ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPILICATION: IBODAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERIArr. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT,AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENTOF `(HE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKME COMPEN!:2=CE AN2 RCW 18.27. SlGj��ftOWNER DATE SfNED CHECKED BY ITYP!n7r I CJ"7 OCCUPA:E GROUP SPECIAL INSPECTOR XREA OCCUPANT REQUIRED[:] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REaD MENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 10/01 VALUATION $ FEE I Description I FEE Plan Check Building Plumbing Mechanical 1 Grading Recording Fee Engr. Review City Surcharge_ Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection Total Amount Due Landscapelnsp. Receipt # 1g:71.i AP LICATION APPROVAL CALL This application Is not a permit until signed by the Building otflcial or his/her Deputy: and roes are paid, and FOR INSPECTION recelpt1.9 ocknowledged In space provided. OFELCIALS 61GATURE DA E "A'35) 771-0220 RELEASEb'SV----bATE EXT 1333 771-0221 ORIGINAL - FILE - YELLOW - INSPECTOR FAX PINK - OWNER - GOLD - ASSESSOR I= Z 0 4 0 m =06 us � am a M a -48 0 C 3� C m 10 eft o -n n 3� C M M CO. Fn C 0) Z 0 m z 0 4 0 m =i 9 ro 4 am c ma 0 -40 0 C M M Z C) -1 CO) 0 -n n FTi M C3 65 0 o rr; C (j) rl V) M 0 z z z 9 0 m ocaprvl.doc.l:temp:bldg:forms6/98 0 q . kTE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEnWE OF BUSINESS IJ -I)CAr c Lr_�\ 4,1 AAAL`2 I MAILING ADDRESS 2.2(,15 9-ZA Avi'w CITY ZIP TELEPHONE NAME CITY ZIP ITELEPHONE NAME Ila --\� '1 3 � _� ADDRESS ? () -7-7 Yy crry ZIP TELEPHONE cloz I c,4H -71 STATE LICENSE NUMBER EXPIRATJON DATE _VaQc� a� Ir 9-71, L- PROPERTY TAX ACCOUNT PAR EL .1 9. PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDA . EBB 2.-2�0 L)2 9 a AV4 W PLAT NAME/SUBDIVISION NO. T NO. LID NO. LID FEE S ir.SCPApproved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Porrr,* Required Street Use Per"(M PmWN EXISTING — PROPOSED trapection raquired Sid*ws* ReWired REQUIRED DEDICATION— FT UnderWound Wking roquIred 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE VARIAN0E OR CU SHORELINE OR ADBO INSPECTION BONI), STI REQ'D 0 POSTED FIRE MARSH 13 YES 13 N SEPA REVIEW IDTM=T t 149 HEIG COMPLETE EXEW Mai I PROPO�Ek EXP TANKRL, RqMOVAL, - I I nV �nimnj I a IRED SETBACKS I % PROPOSED SETBACKS (Ft) [3 NEW EYRESIDENTIAL PLUMBING / MECH ALLOWED PRC ;;8SED F7RZINT SIDE REAR FRONT. LIRSIDE REAR ADDITION 13 REMODEL [3 COMMERCIAL [3 APARTMENT PLIANCE OR cCo,,mN,E OF USE 8113N La PARKING G REVIEWED BY DATE L - I REQ`D I PROVIDE �YJING REVIEW! r] REPAIR 0 GRADING CY08 c3 FENCE X ( — FT) REMARKS . 4- [3 DEMOLISH MO;TANK [3 OTHER GARAGE RETAINING WALL CARPORT ROCKERY nyPE OF HAP BUSINESS OR AMMA EXPLAIN: RENEWAL CHECKED N OCCUPA�, GROUP ov-% C* CA 0 A BY I TYP!= NUMBER DNWU BER CRITICAL W — OF M AREAS SPECIAL INSPECTOR IXREA OCCUPANT ELLINr LU� LOAD 0i i1A All NUMBER STOMES UNITS REQUIRED YES DELSMSE WORK.T? BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECVD CA ODS4 0 all QV% (A ST V ]VALUATION $ --j—FEE Description FEE Description Plan Check HEAT SOURCE GLAZING % LOT SLOPE % Building PLAN CHECK NO: VESTED DATE Plumbing Mechanical TIRIS PWMrr AUTHORIZES 09M TRE WORK HOTEIL TN8 PERMIT COVERS WORK TO SE DONE ON PffiVATE PROPERTY ONLX ANY CONSTRUICTIION ON THE PUBLIC Grading Recording Fee DOMINN (CUMN, SIDEWALKS. DRIVEWAYS, MARQUEES,'ETC.) WILL REQUIRE SEPARATE PEMSSIOIC Engr. Review City Surcharge PEWrrAPPUCA1nON:* 1W DAYS PERMTF UUM I YEAR - PROVIDED WORK 18 STARTED WITHiN 180 DAYS Engr. Inspection State Surcharge SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF NS OR HER.APOUSE, HEIRS, ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit IN INTERESTAGREES TO,INDEMNIFY. DEFEND AND HOLD HARMLESS11HE CrTY OF. , - ANY AND - EDMONDS, WASHINGTON, i rrs OFFICIAIA EMPLOYE AGENTS FROM, %.. . 1 1. 1- Fire'RevieW Receipt # NATURE, ALL CLAIMS FOR DAMAGES OF WHATEVER' DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OFTHIS PERMIT. ISSUANCE OF THISPERIMIT SHALL' NOT BE Fire Inspection Total Amount Due 4--,< DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANYORDINIANCE PROVISION.- Landscapelnsp.1 Receipt # I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIGN: THAT THE INFORMATION APPLICATION APP ROVAL GIVEN IS CORRECT' . AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF WEN THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL TWs application Is not a Pwn* UntU signed bY the TKK AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED hINVIOLATION OF THE LABOR COVE OF THE STATE OF WASHINGTON RELATING TO Building OMcW or his/her DeputY: and Fees we paid. wW FOR INSPECTION rocelpt fik acknovAefted In SMOq proAded. WORKME." COMPENSAPP"lt�"CE ANI) RCW 18.27. 9 kTUR DAIE SIGNA (OwNF8 DATE SIPNED SIG (425) 7e IX,1, - 3 q/ /,, .1 _n42 n ___ _�L,_k RELEASE10"BV-_—" E ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1 -A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE * YEUDW-INSPECTOA CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR z 0 4 0 IT! ra In 0 M V) o -n n M M rn C M 0: X z 0 0 11711